The Old Vicarage Residential Care Home

The Old Vicarage Residential Care Home is registered to provide personal care and accommodation to 33 people who may be living with a sensory impairment, physical disability or dementia. At the time of the inspection 26 people were using the service.

People’s experience of using this service and what we found

The provider had actively worked to make improvements in the service to improve people's experiences, but further time was required to ensure the level of governance and oversight that had been implemented could embed and become fully effective.

Infection prevention and control processes in relation to practice and the environment did not always support best practice guidance and required additional work.

People living at The Old Vicarage felt well cared for. We received positive feedback from people, staff, relatives and health professionals about the service.

Staff were recruited and deployed safely and demonstrated an understanding of the principles of keeping people safe.

Risks to people were assessed and managed. People received their medicines as prescribed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 30 March 2021) and there were breaches of a regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulation.

At our last inspection we recommended the provider review their medication processes to ensure they are followed correctly, and accurate records are kept. At this inspection we found the provider had made improvements.

Why we inspected

We carried out an announced focused inspection of this service on 19 and 21 January 2021. Breaches of a legal requirement were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements.

The overall rating for the service is good. Please see the safe and well-led sections of this full report.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last inspection, by selecting the 'all reports' link for The Old Vicarage Residential Care Home on our website at www.cqc.org.uk

Recommendations

We have made a recommendation about infection prevention and control practice.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Old Vicarage Residential Care Home is registered to provide personal care and accommodation to 33 people who may be living with a sensory impairment, physical disability or dementia. At the time of the inspection 15 people were using the service.

People’s experience of using this service and what we found

Quality assurance systems were not effective and failed to identify shortfalls which placed people at risk of receiving a poor-quality service. There was a lack of oversight from the provider and limited evidence provided regarding monitoring systems and engagement with people who used the service and their relatives.

Accidents and incidents were monitored and analysed, though this was not completed in a robust manner which meant learning opportunities could be missed.

People’s medicines were appropriately administered, although consistent guidance was not always available, and some records were not properly completed. We have made a recommendation about medicines.

Staff ensured people lived in a clean and tidy environment. Infection prevention and control measures followed government guidance.

People were protected from the risk of abuse because staff had the relevant skills and knowledge to raise safeguarding concerns and were attentive to people’s safety. There were enough staff to meet people’s needs safely and in a timely manner.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However, the policies and systems in the service did not support this practice.

The management team promoted a person-centred culture which was reflected in the positive attitude and caring approach staff showed. The management team supported staff and worked closely with relevant professionals.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 12 April 2018).

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We found there was a concern with records, so we widened the scope of the inspection to become a focused inspection, which included the key questions of Safe and Well-led. No areas of concern were identified in the other key questions, therefore we did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Old Vicarage Residential Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service.

We have identified a breach in relation to risk monitoring, record keeping and addressing quality shortfalls at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Since our last inspection two managers’ had withdrawn their applications to register with the Care Quality Commission (CQC). The last registered manager in post voluntarily resigned their registration on 31 March 2017. It is a condition of registration that all providers must have a registered manager in position to comply with Section 33 of the Health and Social Care Act 2008. This was discussed during our inspection and the deputy manager told us the current acting manager was absent. Since our inspection the deputy manager has submitted an application to register as manager with the CQC. They had received a letter to attend a fit and proper person’s interview in April 2018. This interview forms part of the registration process for all new registered managers.

People were protected from avoidable harm and abuse. Systems were in place to record and analyse concerns and included actions the provider had taken to safeguard people. Staff were knowledgeable about potential types and signs of abuse and knew how to report internally and to external agencies.

Risks had been identified and assessments completed and regularly reviewed each month. These included guidance for staff on how to reduce risks to ensure people received safe care and treatment. The provider had processes in place to manage safe administration, disposal, ordering and storage of medicines.

The acting manager reviewed people’s dependency levels monthly to ensure appropriate staffing levels were in place. The provider had robust recruitment processes in place which included pre-employment checks to confirm new applicants were of suitable character prior to commencing their employment.

Staff were knowledgeable about people’s needs and specific health conditions. The provider ensured staff received training and regular supervisions to support them in delivering person centred care to people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff worked with people to understand their likes, dislikes and preferences so they could build person centred care plans. This ensured people’s well-being, privacy, dignity and independence were respected.

The provider had equality and diversity policies in place. Staff understood and valued people’s diverse needs and recognised the specific individual needs of each person.

Staff delivered person-centred care in line with the information held in people’s care plans. People felt supported to live as they had chosen and enjoyed a range of daily activities and events organised by the provider.

Staff, relatives and people living at the service told us they knew how to complain should they need to and felt confident that management would address their concerns.

The provider sought feedback from staff, relatives and people living at the service to continually improve practices and empower people to voice their views and opinions which were utilised to improve the running of the service.

Quality assurance systems highlighted any areas that required attention to ensure the service remained effective. Regular audits were completed by senior members of staff to ensure best practices were being followed and to highlight any areas that required development, such as additional staff training when minor concerns had been identified.

Further information is in the detailed findings below.

The Old Vicarage Residential Care Home is a home for older people in Skidby. The detached house accommodates 33 people in comfortably furnished and decorated shared and single bedrooms and has plenty of lounge and dining space. The registered provider has places for 33 people but prefers to operate at 29, thus using four shared bedrooms as singles, giving the effect that all rooms are single occupancy. Gardens are ornamental and well maintained. There is a passenger lift to upper floors and there are ramps into the home from the outside. There is a car park to the rear of the property for approximately ten cars.

At this inspection we found there were 19 people living in the service, plus three people who were in the ‘Time to Think’ beds. These were short stay beds utilised by the Hull Royal Infirmary to help get people out of hospital and back into their own homes. People using the Time to Think beds usually stayed for between seven and twenty-eight days in the service before moving back into their own homes. The age range of people using the service was between 79 and 102 years.

The registered provider is required to have a registered manager in post and there was a registered manager at this service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People who used the service and their relatives told us they had been consulted about care and support and we found that they received the care they required to meet their needs. We noted that the recording in two care files could be improved, but this had already been picked up in a recent care plan audit and was being addressed by the registered manager.

People told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and that there were enough staff to meet people’s needs. Staff had been employed following robust recruitment and selection processes. Medicines were administered safely by staff and the arrangements for ordering, storage and recording were robust.

People’s nutritional needs had been assessed and they told us they were satisfied with the meals provided by the home.

People spoken with said staff were caring and they were happy with the care they received. They had access to community facilities and most participated in the activities provided in the service.

Staff received a range of training opportunities and told us they were supported so they could deliver effective care; this included staff supervision, appraisals and staff meetings.

The registered manager monitored the quality of the service, supported the staff team and ensured that people who used the service were able to make suggestions and raise concerns. We saw from recent audits that the service was meeting their internal quality standards. The registered manager was described by people, relatives and staff as being ‘open and friendly’ and there was an ‘open door’ policy as far as they were concerned.

We found that the changes were sufficient to show that improvements had been made in auditing areas of the service and in seeking peoples' views of their care and support. This meant that the service was once again in a position to be able to monitor the quality of care and support it provided, the safety and suitability of the environment, the level of staffing skills and the effectiveness of care practices. Therefore people were more confident improvements would be made in meeting their needs.

We found that before people received any care they were asked for their consent and the provider acted in accordance with their wishes. People confirmed to us that this was the case and we saw evidence of consent being given to the implementation of care plans in the form of peoples' signatures.

We were told that peoples' needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We saw care plans to confirm this. People were satisfied with the service of care they received though some of them thought it could have been better. They said, "Some staff are very good, others are not', 'Oh I am quite satisfied here', 'Most of the girls are lovely' and 'The food is good and the staff look after us well'. They said, 'It's not bad here, I could be a little more comfortable if it was a bit warmer".

We found that peoples' health, safety and welfare was protected when more than one provider was involved in their care or when they moved between different services. This was because the provider worked in cooperation with others.

When we looked round the premises we found that there were effective systems in place to reduce the risk and spread of infection and the service was clean and hygienic. People were protected from the risk of infection because appropriate guidance had been followed.

When we looked round the premises we also saw that the provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. Peoples' bedrooms were safe and they had personalised them to their liking.

People were protected from unsafe or unsuitable equipment because the provider made sure equipment was suitable, safe and properly maintained.

When we looked at staff files we found that staff received appropriate professional development. Some of them had completed the mandatory training and others, new staff, were booked to do so. Staff received appropriate supervision.

When we looked at the quality assurance system we found people that used the service, their representatives and staff were not asked for their views about their care and treatment. We also found there were insufficient audits on the service to accurately determine its performance delivery.

People told us they were satisfied with the care and support they received. One person said, 'We are well looked after." We saw and heard staff asking people about the help they needed and staff provided it in an efficient manner, with regard to peoples' privacy, dignity and respect. Another person said, "The staff are nice. We get a choice of foods," while a third person said, "We can pretty much do as we like.'

We saw staff being helpful and caring and including people when giving them support. We saw that the environment in the main lounge was not as good as it could be with regards to lighting, temperature and space for manoeuvring and the provider was informed.

We saw that case files had care plans that had been reformatted since our last visit to The Old Vicarage. These had improved. We looked at the medication administration systems within the home and saw that they were satisfactory in the main, with some minor points made for consideration by the provider.

We also saw that staffing levels were appropriate once an initial identified staffing shortage had been rectified. We saw that there was a complaint procedure for handling complaints and people told us that they knew how to complain if need be. We saw that records had been accurately maintained and were held safely and appropriately.